Friday, August 7, 2015

Pre-op Appt, Med appeals

Well what a day? Not bad but a bit frustrating for sure, definitely spent enough time on the phone between both my insurance pharmacy benefit providers re the Ivabradine. I had kind of forgotten about it but b/c the Ivabradine (Corlanor to insur.) is so newly approved it is not yet on my primary insurers formulary (approved drugs list) so instead of a Prior Auth having needed to be done apparently the right step would have been for my EP (Heart Rhythm) dr. to call and have what is called a 'Peer to Peer' discussion directly with the Medical Director re why the med is recommended/needed and the MD will then decide if the med is approved.
Ironically my secondary insurer also denied the med "b/c you need to have tried other things first", lol? I almost choked laughing when the Rep said that, I saw the prior auth form that was submitted, did they? She asked me what we've tried and I listed every single med they would want pts. to try. Seriously so WT-Heck is the problem, then? I did call and start the over the phone appeal process w the secondary insurer so they in turn call my Heart Rhythm doc and confirm the information with them and see if there is any additional info they want to add. The Customer Service Rep at Cigna said the whole process takes about 72hrs for an expedited review though that is a little confusing given it is the wknd and she said that timeframe still includes the wknd. I am not sure.. I guess it doesn't entirely matter as my Primary dr. would prefer we wait to start the new med, for safety reasons at minimum till after the shunt surgery is done and perhaps while I am still in-pt at UW with Dr.Bragg.
I know in talking to Dr.Bragg yesterday she expressed she would probably want to talk to my Cardiology Team though more b/c she didn't want Anesthesia to get upset about any recent cardiac changes (both the actual heart changes and med changes I assume) which I commented to her I had written about the very same thing, expecting if anything Anesthesia would be the one to raise concerns or some issue with this surgery and the recent heart problems. Ding, ding, guess I was likely spot on.

Regarding today's Pre-op Appt, ironically my PMD (who does an amazing job keeping up on the various, on-going and often varied but sometimes endless issues) said to me that she and the Dean Primary drs. had just received a memo on the new Heart Failure med my Team is working to get approved and she didn't think we'd have a problem getting it approved. Super ironic, hey? Apparently Dean recommends it just hasn't put it on their own insur. plan recommended drug formulary yet!?! She made the comment "Your on the cutting edge of medicine, when I got the memo I actually knew what the drug was b/c of you!" Keeping in mind this med is newly approved back in May, most docs have never used it,- I am my EP drs. 2nd pt. on it and my PMD's 1st patient I guess she may be right. Non-the-less whatever I am I just hope it helps and hope we can avoid a 3rd OHS for a good long(er) while.. I have to admit I am a little taken aback how many times I've heard 'your case is extremely complex' or 'yours is the most challenging case I have' from my Providers this wk!?!..

Actual recommendations leading up to surgery from my PMD are:
-Wait to change to new heart drug until after surgery - either in-patient or once done with surgery.
-Hold Coumadin 5 days prior to surgery
-Hold aspirin 6 days prior to surgery
-Restart Coumadin and Aspirin day after surgery (per Dr.Bragg)
-Morning of surgery take Cardizem and Digoxin (the Cardizem is the drug we're stopping 5 days prior to starting Ivabradine, so have to check that w Dr.Kovach and Dr.Bragg I guess).
-Hold Lasix and Spironolactone morning of (these take fluid off)
-Check INR day prior to surgery (i'll also have Port accessed at the same time)

That's all for now, say a prayer for the Ivabradine approval w the 2 appeals (peer to peer approval and the Cigna appeal)!
Tmrw (Monday) we (family) are headed up to Green Bay, to the Amusement Park owned by the city. There's a new, bigger replacement train with a much bigger area it drives along (around the amusement park) as well as 3 new rides that are being added. Last yr a new ride was added. The park is AWESOME! I am not so sure i'll be able to make it up the giant slide (100ft tall) but sure going to try or atleast once, it is awesome! Should be a fun day!
In any case will try to add some pics in one of the next updates. Hoping to hear something about the med this week to,

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